title: Domino versus deceased donor liver transplantation: association with early graft function and perioperative bleeding.
abstract: This study sought to evaluate the potential impact of domino liver transplantation (DLT) on initial graft function and early postoperative outcome in patients with cirrhosis in a Portuguese liver transplantation center. A retrospective comparative analysis was performed between 77 domino recipients (from familial amyloidotic polyneuropathy donors) and 91 deceased donor recipients, all submitted to primary elective whole liver transplantation, using the piggyback technique, in a 42-month period. Outcome parameters included graft dysfunction (defined as either primary nonfunction or initial poor function, according to the Ploeg-Maring criteria) and Clavien II-IV complications in the first postoperative week. Domino and deceased donor recipients had similar preoperative severity indices (Child-Pugh classification and Model for End-Stage Liver Disease score) and immediate postoperative severity scores (APACHE II [Acute Physiology and Chronic Health Evaluation II] and SAPS II [Simplified Acute Physiology Score II]). In DLT, donors were younger, cold ischemia time was shorter, and intraoperative transfusion requirements of packed red blood cells and fresh-frozen plasma were significantly lower. Graft dysfunction incidence was 3.4-fold lower in DLT: 5.2% (only 4 cases of initial poor function) versus 18.0% (1 primary nonfunction and 15 cases of initial poor function), P = 0.010. Postoperative bleeding was the most frequent early Clavien II-IV complication (n = 29, 17.3%), with an incidence 2.2-fold lower in domino recipients. A statistically significant difference was not found in the other analyzed Clavien II-IV complications, intensive care unit stay, mechanical ventilation time, intensive care unit mortality, and 1-year survival rate. In conclusion, in this study the younger donors and shorter ischemic time associated with DLT may provide a protective role in regards to graft dysfunction and perioperative bleeding, which are 2 important determinants of early morbidity after liver transplantation.
authors.affiliation: Intensive Care Unit, Curry Cabral Hospital, Lisbon, Portugal. gastregas@hegasmoniz.min-saude.pt
authors.forename: Miguel
authors.initials: M
authors.lastname: Bispo
authors.forename: Paulo
authors.initials: P
authors.lastname: Marcelino
authors.forename: Hugo Pinto
authors.initials: HP
authors.lastname: Marques
authors.forename: Américo
authors.initials: A
authors.lastname: Martins
authors.forename: Rui
authors.initials: R
authors.lastname: Perdigoto
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Aguiar
authors.forename: Luís
authors.initials: L
authors.lastname: Mourão
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
mesh_terms: D000328:Adult; D000367:Age Factors; D028227:Amyloid Neuropathies, Familial / Q000235:genetics* / Q000401:mortality; D016009:Chi-Square Distribution; D050377:Cold Ischemia / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011174:Portugal; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome